"To initiate, augment and intensify action against those causes of massively prevalent disablement for which there exists a potential for prevention and control, which can be delivered through existing delivery systems and available infrastructure." -mission statement, Impact India Foundation
We left early Friday morning for our first visit to a rural area. As soon as the bus was out of the city, I felt a huge relief. For the first time we were able to witness the beauty of nature in India. I was starting to get a bit emotionally wound up observing so much poverty among the city communities, but going out to a more rural area seemed much more familiar to me. In January I had the opportunity to do a service project with Global Brigades in Panama. We spent 9 days building justa stoves and slow sand water filters for a small community three hours from Panama City. That was my first real experience with poverty as we spent 9 days sleeping on the concrete floor of the school with little running water. The people in the community lived without electricity and most did not have access to running water let alone clean water. A lot of those experiences came back to me as we made our way to the Thane District of Maharashtra.
The Community Health Initiative (CHI) is a Project of the Government of Maharashtra in association with the Impact India Foundation. The CHI mainly focuses on reduction of future incidence of disablement and eradication of existing disabilities via prevention and curative measures, as well as health communication. Prevention programs focus on immunization, nutrition, maternal and child health education, and water management for the empowerment of the community.
We first visited an ashramshala, a tribal residential school, to meet with the government physician working in the community. The school children were so excited to greet us, and a select group of girls in the class known as “health monitors” presented each of us with a red rose. The health monitors have the responsibility of recording BMI measurements, and keeping track of illnesses that their classmates report to them. We watched the girls record weight and height entirely on their own. With each health monitor responsible for 10 of her classmates, this is an incredible method of empowering young girls. I was actually really surprised to learn of this model and think it is a great way to engage the schoolgirls and teach them to take an active role in not just their own health, but the health of their peers. While at the ashramashala, we also assisted the physician in distributing vitamin A and folic acid supplements. The girls let us know that they really enjoyed taking the supplements because of the taste, and they all knew why it was important to take their supplements every day.
Our next stop was a visit to a government auxiliary nurse midwife at the women and children center. We listened to the nurse give a talk to the women about the importance of breastfeeding and best practices. She spoke about how important the first feeding is, and ensuring the baby is strictly breastfed for at least the first 6 months of life. Much of what the nurse had to say included things that we learn about in class and it was very positive for all of us to see these points being reinforced in exactly the way we are taught. The nurse also performed a hemoglobin test for anemia on one of the schoolchildren. We watched her administer the test right outside the center in front of our entire class and several of her classmates. The girl ended up testing positive for anemia, and what I found most interesting was her reaction to what the nurse was telling her. A group of us spent a few minutes discussing how in the US, there would never be so many people listening to the interaction between a patient and a nurse. Most of us would feel uncomfortable with so many people having access to our health information, and might not want others to know of our health status related to any disease. The little girl didn’t seem to think anything of it, and it seemed very normal for members of community to be aware of other’s health status. When the nurse asked the little girl what she was going to do about testing positive for anemia, she said she would eat more green leafy vegetables and take her supplements. It was fulfilling to hear that she had learned something from the educational sessions that the CHI has been providing for the children.
Next we visited the primary health center in Saiwan where the government physicians are primarily based. We received a tour of the facilities and discussed how the clinic is operated. The patient exam rooms and delivery room did not contain the modern amenities that we are used to, but I was impressed with how well kept they were. The way the clinic is run is not much different than the way community health centers are run in the US, but facilities like this one are decades behind the ones we are used to as far as equipment and staffing. Our last stop was a visit to another ashramshala where the lifeline express mobile clinic was conducting eye exams. The mobile clinic had performed over 80 eye exams by the time we got to the school late afternoon.
I was really inspired by our visits to all of the sites where the Community Health Initiative is working. Their services have reached hundreds of thousands of people and continue to have a positive impact on the health of people living in tribals in rural Thane District. The model that they have created is efficient in utilizing existing available delivery systems and existing infrastructure, and will ultimately provide the government with a successful blueprint to implement similar models in rural areas throughout India.
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